MEDICARE: KELSEY WIELAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471S1302X	Sonography Radiologic Technologist	196792

General Provider Information

NPI Number	:	1932057981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY WIELAND

Provider Business Mailing Address
First Line	:	810 HEARTLAND CT
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-8155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 N MILWAUKEE ST STE 180
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-0726
Country	:	US
Telephone Number	:	208-615-4858
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “ KELSEY WIELAND ” Practice Location

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